TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Bacterial vaginosis          TEALE FENNING Forum Index -> MRCOG Part 2: MCQ & Past Paper questions View previous topic :: View next topic   Author Message bluesky Joined: 20 Sep 2008 Posts: 49 Posted: Wed Oct 08, 2008 4:11 pm    Post subject: Bacterial vaginosis Bacterial vaginosis can be diagnosed on culture of high vaginal swab Bacterial vaginosis can be successfully treated by single dose oral metronidazole. Bacterial vaginosis is only seen in women who are sexually active Bacterial vaginosis has a recognized association with smoking. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Wed Oct 08, 2008 4:37 pm    Post subject: F......alse _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top bluesky Joined: 20 Sep 2008 Posts: 49 Posted: Wed Oct 08, 2008 4:54 pm    Post subject: I would say 1. true 2. true 3. false 4. true (its more common in smokers) Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Wed Oct 08, 2008 6:35 pm    Post subject: Give us some references then. I'll have a go at explaining myself: bluesky wrote: Bacterial vaginosis can be diagnosed on culture of high vaginal swab. My doubts relate to the word / phrase "on culture of a high vaginal swab": Amsel's diagnostic criteria (Amsel R,. et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983 Jan;74(1):14-22) require more than a simple HVS result which actually does not constitute any of the 4 criteria: 1. A homogeneous vaginal discharge (usally grey) 2. Positive whiff test (a fishy odour produced when KOH is added to the vaginal secretions due to the release of specific amines - cadaverine and putrescene - don't you just love the names these scientists come up with! - ) 3. Clue cells on microscopy 4. Vaginal pH > 4.5 You need 3 / 4 for the diagnosis. The alternative is to use the Hay/Ison or Nugent criteria but these require the assessment of a Gram stained vaginal smear The Hay/Ison (Hay et al., 1994) criteria are: Grade 1 (Normal): Lactobacillus morphotypes predominate. Grade 2 (Intermediate): Mixed flora with some Lactobacilli present, but Gardnerella or Mobiluncus morphotypes also present. Grade 3 (Bacterial Vaginosis): Predominantly Gardnerella and/or Mobiluncus morphotypes. Few or absent Lactobacilli. Neither relate to the culture of a HVS So I say fffffff.........alse Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Wed Oct 08, 2008 6:41 pm    Post subject: Re: Bacterial vaginosis bluesky wrote: Bacterial vaginosis can be successfully treated by single dose oral metronidazole. Doesn't it need more (i.e. a course) if treated orally and with metronidazole - not sure if a single vaginal treatment with clindamycin is sufficient however. I may be wrong so please look up and get back to us. bluesky wrote: Bacterial vaginosis is only seen in women who are sexually active. Only = false in most / many cases plus we know BV is no sexually transmitted although is seen more frequently in sexually active women and is associated withan increased incidence of STIs I think??? bluesky wrote: Bacterial vaginosis has a recognized association with smoking. We normally advise smoking = true but I am not sure on this occasion. I think not. Back to top masooma Joined: 22 Jan 2007 Posts: 10 Posted: Thu Oct 09, 2008 5:15 am    Post subject: hello Nick and bluesky, I would go for, 1. true 2. true 3. false 4. false reference is from current obs and gynae 2006 (currently known as obstetrics and gynaecology and reproductive medicine) it says, "it is important to note that isolation of Gardnerella vaginalis on a HVS is a poor test for BV as upto 55% of women can be asymptomatic carriers of this" what i understood from this is that it can be diagnosed on HVS but it is a poor test. Recommended treatment regimens for BV: Metronidazole 400mg PO twice daily for 5-7 days or Metronidazole 2g PO as a single dose. Risk factors associated with BV: Younger age black ethinicity vaginal douching use of intrauterine device. it doesnot mention smoking and since the question says recognised association so i would go for false. Back to top bluesky Joined: 20 Sep 2008 Posts: 49 Posted: Thu Oct 09, 2008 9:13 am    Post subject: Hi Nick u forced me to open some books I knew about Amsels Criteria but the fact is that we find BV on High vaginal swab results very often in hospital 2. it can be treated by 2 G Metronidazole oral dose 3. false, can be seen in women who are not sexually active 4. true (Obs & Gynae by David Luesley and Baker ) common in blacks, in IUCD users and smokers Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Thu Oct 09, 2008 2:54 pm    Post subject: Re: Bacterial vaginosis bluesky wrote: Bacterial vaginosis can be diagnosed on culture of high vaginal swab False It will often be misdiagnosed if we were to use culture of HVS as upto 55% of women can be asymptomatic carriers of this. So it should not/cannot be used for diagnosis of BV Last edited by cpeedahsa on Fri Oct 10, 2008 4:05 pm; edited 2 times in total Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Thu Oct 09, 2008 3:00 pm    Post subject: Re: Bacterial vaginosis bluesky wrote: Bacterial vaginosis can be successfully treated by single dose oral metronidazole. True It can be used to successfully treat ((NOT if pregnant/breastfeeding) Ref: Clinical Effectiveness Group, British Association for Sexual Health and HIV (BASHH). National guideline for the management of bacterial vaginosis. London (UK): British Association for Sexual Health and HIV (BASHH) Last edited by cpeedahsa on Thu Oct 09, 2008 3:02 pm; edited 1 time in total Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Thu Oct 09, 2008 3:01 pm    Post subject: Re: Bacterial vaginosis bluesky wrote: Bacterial vaginosis can be successfully treated by single dose oral metronidazole. True These are the recommended regimens for BV as per Clinical Effectiveness Group, British Association for Sexual Health and HIV (BASHH). National guideline for the management of bacterial vaginosis. London (UK): British Association for Sexual Health and HIV (BASHH) Metronidazole 400-500 mg twice daily for 5-7 days (A) or Metronidazole 2 g single dose (A) Alternative Regimens Intravaginal metronidazole gel (0.75%) once daily for 5 days (A) or Intravaginal clindamycin cream (2%) once daily for 7 days (A) or Clindamycin 300 mg twice daily for 7 days (A) or Tinidazole 2 g single dose (A) http://cks.library.nhs.uk/bacterial_vaginosis/management/quick_answers/scenario_bacterial_vaginosis/prescriptions/oral_metronidazole Last edited by cpeedahsa on Fri Oct 10, 2008 4:12 pm; edited 1 time in total Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Thu Oct 09, 2008 3:04 pm    Post subject: Re: Bacterial vaginosis [quote="bluesky"] Bacterial vaginosis is only seen in women who are sexually active quote] Obviously False Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Thu Oct 09, 2008 3:09 pm    Post subject: Re: Bacterial vaginosis bluesky wrote: Bacterial vaginosis has a recognized association with smoking. True It has been associated with racial origin, smoking, sexual activity, and vaginal douching. Bacterial vaginosis is more common in black women, women who smoke, women who are sexually active compared with virginal women, and those who use vaginal douches. Also-- Use of vaginal foreign bodies, perfumed soaps, Intrauterine device New male sexual partner, Sex with another woman , No condom use trend toward association There is abundant evidence that BV is associated with smoking. http://www.sogc.org/guidelines/documents/gui211CPG0808.pdf Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002;51(RR-6):1–78. Back to top masooma Joined: 22 Jan 2007 Posts: 10 Posted: Fri Oct 10, 2008 5:07 am    Post subject: thanks cpeedahsa for the correction. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Oct 10, 2008 3:59 pm    Post subject: Well done - excellent questions and even better answers guys. I remain confident that the HVS one is false but you have totally convinced about single dose metronidazole and smokers! I give myself 50% and if I am wrong about the HVS then only 25% Oh dear - anyway the most important thing is that I will now get 100% and I will remember this for ever which would not necessarily be true had I simply read a review article or guideline. N Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Fri Oct 10, 2008 4:06 pm    Post subject: Nick Raine-Fenning wrote: Well done - excellent questions and even better answers guys. I remain confident that the HVS one is false but you have totally convinced about single dose metronidazole and smokers! I give myself 50% and if I am wrong about the HVS then only 25% Oh dear - anyway the most important thing is that I will now get 100% and I will remember this for ever which would not necessarily be true had I simply read a review article or guideline. N Nick, I think you are right on the HVS question. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Oct 11, 2008 10:52 am    Post subject: Thanks Asha - you and I need to stick together Back to top Display posts from previous: All Posts1 Day7 Days2 Weeks1 Month3 Months6 Months1 Year Oldest FirstNewest First         TEALE FENNING Forum Index -> MRCOG Part 2: MCQ & Past Paper questions All times are GMT Page 1 of 1   Jump to: Select a forum Announcements----------------Forum AnnouncementsExam InformationCourse Announcements Examinations----------------MRCOG Part 1: EMCQsMRCOG Part 2: MCQ & Past Paper questionsMRCOG Part 2: EMQs - Extended Matching QuestionsMRCOG Part 2: Short Answer EssaysMRCOG Part 2: Objective Structured Clinical Examination - the OSCEDRCOG: the Diploma ExaminationMFFP: Membership of the Faculty of Family Planning and Reproductive Health Care of the RCOGPLAB: The Professional and Linguistic Assessment Board test General Discussion----------------Open ForumRCOG News & UpdatesThe Study Buddy SchemeKey Facts in O&GGuidelines & ProtocolsRecommended ReadingUseful WebsitesThe Market PlaceHow things work in the UKHow do you say that? Teale Fenning Courses----------------Our UK CoursesOur Overseas CoursesOur Correspondence CourseCourse AdministrationCourse FeedbackAccommodationOther Courses Training & Career Development----------------Basic Speciality Training in O&GSubspeciality Training & Special Skills ModulesAcademic TrainingResearch & AuditThe Curriculum Vitae or CVInterview SkillsMedical EducationPublication & Presentation SkillsTraining Courses, Conferences, & MeetingsThe Job MarketClinical Attachments  You cannot post new topics in this forum You cannot reply to topics in this forum You cannot edit your posts in this forum You cannot delete your posts in this forum You cannot vote in polls in this forum Powered by phpBB © 2001, 2005 phpBB Group